Dietary Interventions for Menopausal Symptoms: A Systematic Review.

BACKGROUND

Menopausal transition significantly affects women's health and quality of life largely driven by declining estrogen. While pharmacological therapies remain first-line treatment, interest in dietary interventions as accessible, non-pharmacological strategies is growing.

OBJECTIVE

To systematically evaluate effectiveness of dietary interventions on vasomotor, psychological, and cognitive symptoms in menopausal women.

METHODS

This systematic review included 15 randomized controlled trials (n=1,952 participants) conducted according to Cochrane methodology and PRISMA guidelines (PROSPERO: CRD42024610754). Databases searched included CINAHL, Cochrane, Embase, PubMed, and PsycINFO. Eligible studies included women aged 40-65 experiencing menopause-related symptoms (or reporting relevant outcomes), and evaluated whole food-based interventions, structured dietary patterns, or energy restriction, excluding supplement-only trials. Risk of bias was assessed using the Cochrane Risk of Bias 2 tool, and certainty of evidence was assessed using GRADE. Random-effects meta-analyses were conducted where appropriate.

RESULTS

Twelve trials included postmenopausal women, two included peri- and postmenopausal women, one included all menopausal stages, and one did not specify status. Soy-based interventions may reduce hot flash frequency and severity (SMD = -0.79; 95% CI -1.34 to -0.23; I2 = 69%; n = 206, 4 trials (5 comparisons)), but not overall vasomotor symptoms (SMD = -0.43; 95% CI -1.12 to 0.26; I2 = 86%; n = 259, 3 trials) or psychological outcomes (SMD = -0.21; 95% CI (-0.470 to 0.05); I2 = 0%; n = 236, 3 trials); overall certainty was very low. Other dietary patterns (e.g., DASH, lacto-ovo-vegetarian, MIND) suggested modest benefits for mood and cognition in narrative synthesis. Evidence for flaxseed is inconsistent and intermittent fasting for cognition limited.

CONCLUSIONS

Soy-based dietary interventions may modestly improve vasomotor and psychological symptoms; however, certainty of evidence is very low. Dietary modification represents a feasible, low-risk approach, but larger, high-quality trials with standardized protocols and longer follow-up are required. Registry and registry number for systematic reviews or meta-analyses: PROSPERO: The Impact of Dietary Interventions on Menopausal Symptoms: A Systematic Review (CRD42024610754).